Bruce W. Carter VAMC 1201 NW 16 Street Miami, FL Giovanna Delgado, Psy D

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1 Bruce W. Carter VAMC 1201 NW 16 Street Miami, FL Giovanna Delgado, Psy D

2 What is Elder Abuse? Elder Abuse is the infliction of physical, emotional, or psychological harm on an older adult. Elder abuse can also take the form of financial exploitation or intentional or unintentional neglect of an older adult by the caregiver.

3 Categories Domestic elder abuse generally refers to any of several forms of maltreatment of an older person by someone who has a special relationship with the elder (a spouse, a sibling, a child, a friend, or a caregiver), that occur in the elder s home, or in the home of the caregiver.

4 Categories Institutional abuse generally refers to any abuse that occur in residential facilities of older persons (e.g., nursing homes, group homes, board and care facilities). Perpetrators of institutional abuse usually are persons who have a legal or contractual obligation to provide elder victims with care and protection (e.g., paid caregivers, staff, professionals).

5 Types of Elder Abuse Physical Abuse Defined as the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include, but is not limited to, such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind are examples of physical abuse.

6 Signs and Symptoms of Physical Abuse Signs and symptoms of physical abuse include but are not limited to: Bruises, black eyes, welts, lacerations, and rope marks; Bone fractures, broken bones, and skull fractures; Open wounds, cuts, punctures, untreated injuries in various stages of healing; Sprains, dislocations, and internal injuries/bleeding; Broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained; Laboratory findings of medication overdose or under utilization of prescribed drugs; An elder s report of being hit, slapped, kicked, or mistreated; An elder s sudden change in behavior; and The caregiver s refusal to allow visitors to see an elder alone.

7 Types of Elder Abuse Emotional or Psychological Abuse Defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating the elderly person from his/her family, friends, or regular activities; giving an older person the silent treatment; and enforced social isolation are examples of emotional/psychological abuse.

8 Signs and Symptoms of Emotional/Psychological Abuse Signs and symptoms of emotional/psychological abuse include but are not limited to: Being emotionally upset or agitated; Being extremely withdrawn and non communicative or non responsive; Unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking); and An elder s report of being verbally or emotionally mistreated.

9 Sexual Abuse Types of Elder Abuse Defined as non-consensual sexual contact of any kind with an elderly person. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It includes, but is not limited to, unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing, forcing the person to look at pornography, or forcing sexual contact with a third party.

10 Signs and Symptoms of Sexual Abuse Signs and symptoms of sexual abuse include but are not limited to: Bruises around the breast or genital area; Unexplained venereal disease or genital infections; Unexplained vaginal or anal bleeding; Torn, stained, or bloody underclothing; and An elder s report of being sexually assaulted or raped.

11 Types of Elder Abuse Financial or Material Exploitation Defined as the illegal or improper use of an elder s funds, property, or assets. Examples include, but are not limited to, cashing an elderly person s checks with out authorization or permission; forging an older person's signature; misusing or stealing an older person s money or possessions; coercing or deceiving an older person into signing any documents (e.g., contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.

12 Signs and Symptoms of Financial or Material Exploitation Signs and symptoms of financial or material exploitation include but are not limited to: Sudden changes in bank account or banking practices, including an unexplained withdrawal or large sums of money by a person accompanying the elder; The inclusion of additional names on an elder s bank signature card; Unauthorized withdrawal of the elder s funds using the elder s ATM card; Abrupt changes in a will or other financial documentations; Unexplained disappearance of funds or valuable possessions; Substandard care being provided or bills unpaid despite the availability of adequate financial resources; Discovery of an elder s signature being forged for financial transactions or for the titles of his/her possessions; Unexplained sudden transfer of assets to a family member or someone outside of the family; The provision of services that are not necessary: and An elder s report of financial exploitation.

13 Abandonment Types of Elder Abuse Defined as the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.

14 Signs and Symptoms of Abandonment Signs and symptoms of abandonment include but are not limited to: The desertion of an elder at a hospital, a nursing facility, or other similar institutions; The desertion of an elder at a shopping center or other public location; and An elder s own report of being abandoned.

15 Types of Elder Abuse Neglect Defined as the refusal of failure to fulfill any part of a person s obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in home service provider to provide necessary care.

16 Signs and Symptoms of Neglect Signs and symptoms of neglect include but are not limited to: Dehydration, malnutrition, untreated bed sores, and poor personal hygiene; Unattended or untreated health problems; Hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no heat, or no running water); Unsanitary and unclean living conditions (e.g., dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and An elder s report of being mistreated.

17 Self-neglect Types of Elder Abuse Characterized as the behavior of an elderly person that threatens his/her own health or safety. Self-neglect generally manifests itself in an older person as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medications (when indicated), and safety precautions.

18 Signs and Symptoms of Self-neglect Signs and symptoms of self-neglect include but are not limited to: Dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene; Hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no heat, or no running water); Unsanitary and unclean living quarters (e.g., animal/insect infestation, no functioning toilet, fecal/urine smell); Inappropriate and/or inadequate clothing, lack of the necessary medical aids (e.g., eyeglasses, hearing aids, dentures); and Grossly inadequate housing or homelessness.

19 Who is at Risk? Elder abuse can happen to any older individual. It can affect the aging population across all socio-economic groups, cultures, and races; Women and older elders are more likely to be victimized; Dementia may be a significant risk factor; Mental health and substance abuse issues (of both abuser and victims) may be risk factors; Isolation may also be a risk factor.

20 Cause of Elder Abuse Elder abuse is a complex problem that can emerge from several different causes, and that is often rooted in multiple problems.

21 Possible Causes of Elder Abuse Personal problems of the abuser; Discord in the family created by the older person s presence; A history and pattern of violent interactions within the family; Social isolation; Family stress; Financial burden; Living in overcrowded quarters Person being cared for may be physically abusive towards caregiver. A history of domestic violence

22 Domestic Violence Among the Elderly Domestic violence is an escalating pattern of violence or intimidation by an intimate partner, which is used to gain power or control.

23 Categories of Domestic Violence Against the Elderly Domestic violence grown old; Late onset domestic violence; Retirement Disability Changing roles of family members Sexual changes Some older people enter into abusive relationships late in life.

24 Perpetrators of Domestic Violence Among the Elderly Spouses or intimate partners; The majority are men; Some perpetrators abuse drugs or alcohol.

25 Who is at Risk for Domestic Violence Later in Life Older women whose relationships with their spouses or intimate partners were abusive or strained when they were younger; Older women who enter into intimate relationships late in life.

26 Indicators of Domestic Violence Among Elderly Indicators similar to those associated with physical abuse and/or sexual abuse; Additional patterns also characteristic; Frequency and severity of injuries are likely to increase over time Victims often experience intense confusion and disassociation Violent incidents are often preceded by periods of intensifying tension and followed by periods of apparent contrition on the part of the perpetrators.

27 National Center of Elder Abuse, Bureau of Justice Statistics: research date Elderly Abuse Statistics Data Number of elderly abuse cases in ,961,568 Percent of elderly population abused in % Demographics of Elderly Abuse Victims Percent Percent of female elder abuse victims 67.3 % Median age of elder abuse victims 77.9 Percent of white victims 66.4 % Percent of black victims 18.7 % Percent of hispanic victims 10.4 % Breakdown of Reported Elder Abuse Cases Neglect 58.5 % Physical Abuse 15.7 % Financial Exploitation 12.3 % Emotional Abuse 7.3 % Sexual Abuse 0.04 % All other types 5.1 % Unknown 0.06 % Family Perpetrated Elderly Abuse Percent of Adult Protective Service cases that involve elderly abuse 68 % Percent of elderly abuse perpetrated by adult children or spouses 66 % Percent of murder victims over 60 who were killed by their own offspring 42 % Percent of murder victims over 60 who were killed by their spouses 24 % Nursing Home Abuse Percent of nursing homes that lack adequate staff to properly 91 % care for patients Percent of nursing homes that have been in violation of elderly abuse laws 36 % Elderly defined as 60 years of age and older

28 Prevention Recognizing and promoting the social attitude of respect for the elderly Education Respite care Social contact and support Counseling

29 Prevention Keep in contact with your older friends, neighbors, and relatives. Be aware of the possibility of abuse

30 Prevention Report suspected mistreatment to your local adult protective service agency or law enforcement. Adult Protective Services Law Enforcement Long-term Care (LTC) Ombudsman Programs Eldercare Locator at Medicaid/Medicare Fraud and Abuse

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